How Is Sleep Apnea Diagnosed and Treated?

Some of the ways to help doctors diagnose sleep apnea include:

A medical history that includes asking you and your family questions about how you sleep and how you function during the day.

Checking your mouth, nose, and throat for extra or large tissues, for example tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (roof of your mouth in the back of your throat).

A sleep recording of what happens with your breathing.

A sleep recording is a test that is often done in a sleep center or sleep laboratory, which may be part of a hospital.

You may stay overnight in the sleep center, although sleep studies are sometimes done in the home. The most common sleep recording used to find out if you have sleep apnea is called a polysomnogram (poly-SOM-no-gram) or PSG.

This test records:

Brain activity

Eye movement

Muscle activity

Breathing and heart rate

How much air moves in and out of your lungs while you are sleeping

The percent of oxygen in your blood

A PSG is painless. You will go to sleep as usual. The staff at the sleep center will monitor your sleep throughout the night. The results of your PSG will be analyzed by a sleep medicine specialist to see if you have sleep apnea, how severe it is, and what treatment may be recommended.

In certain circumstances, the PSG can be done at home. A home monitor can be used to record heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort. For this test, a technician will come to your home and help you apply the monitor you will wear overnight. You will go to sleep as usual, and the technician will come back the next morning to get the monitor and send the results to your doctor.

Once all your tests are completed, the sleep medicine specialist will review the results and work with you and your family to develop a treatment plan. In some cases, you may also need to see another physician for evaluation of:

Lung problems (pulmonologist)

Problems with the brain or nerves (neurologist)

Heart or blood pressure problems (cardiology)

Ear, nose, or throat problems (ENT)

Emotional/Stress problems (Psychologist or psychiatrist)

How Is Sleep Apnea Treated?

Treatment is aimed at restoring regular nighttime breathing and relieving symptoms such as very loud snoring and daytime sleepiness.

If you have mild sleep apnea, some changes in daily activities or habits may be all that are needed:

Avoid alcohol, smoking, and medications that make you sleepy. They will make it harder for your throat to stay open while you sleep.

Lose weight if you are overweight. Even a little weight loss can improve your symptoms.

Sleep on your side instead of your back. Sleeping on your side may help keep your throat open.

People with moderate or severe sleep apnea will need to make these changes as well as others.

Continuous Positive Airway Pressure (CPAP)

CPAP is the most common treatment for sleep apnea. For this treatment, you will wear a mask over your nose during sleep that blows air into your throat at a pressure level that is right for you. The increased airway pressure acts to keep the throat open while you sleep. The air pressure is adjusted so that it is just enough to stop these airways from briefly getting too small during sleep.

Sleep apnea will return if CPAP is stopped or if it is not used correctly. Usually, a technician comes to your home to bring the CPAP equipment. The technician will set up the CPAP machine and make adjustments based on your doctor's orders.

CPAP treatment may cause side effects in some people. Some side effects are:

Dry or stuffy nose

Irritation of the skin on your face

Bloating of your stomach

Sore eyes

Headaches

If you are having trouble with CPAP side effects, work with your sleep medicine specialist and technician. Together you can do things to reduce these side effects, such as:

Using a nasal spray to relieve a dry, stuffy, or runny nose

Adjusting the CPAP settings

Adjusting the size/fit of the mask

Adding moisture to the air as it flows through the mask

Using a CPAP machine that can automatically adjust the amount of air pressure to the level that is required to keep the airway open

Using a CPAP machine that will start with a low air pressure and slowly increase the air pressure as you fall asleep.

People with severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. When using CPAP, it is very important that you follow up with your doctor. If you are having side effects, talk to your doctor.

Mouthpiece

A mouthpiece (oral appliance) may be helpful in some people with mild sleep apnea. Some doctors may also recommend this if you snore loudly but do not have sleep apnea.

A custom-fit plastic mouthpiece will be made by a dentist or orthodontist. An orthodontist is a specialist in correcting teeth or jaw problems. The mouthpiece will adjust your lower jaw and your tongue to help keep the airway in your throat open while you are sleeping. Air can then flow easily into your lungs because there is less resistance to breathing.

Possible side effects of the mouthpiece include damage to your:

Teeth

Gums

Jaw

Follow up with your dentist or orthodontist to check for any side effects and to be sure that your mouthpiece fits.

Surgery

Some people with sleep apnea may benefit from surgery. The type of surgery depends on the cause of the sleep apnea:

Surgery to remove the tonsils and adenoids if they are blocking the airway. This surgery is especially helpful for children.

Uvulopalatopharyngoplasty (UPPP) is a surgery that removes the tonsils, uvula (the tissue that hangs from the middle of the back of the roof of the mouth), and part of your soft palate (roof of your mouth in the back of your throat). This surgery is only effective for some people with sleep apnea.

Laser-assisted uvulopalatoplasty (LAUP) is a surgery that can stop snoring but is probably not helpful in treating sleep apnea. A laser device is used to remove the uvula and part of the soft palate. Because the main symptom of sleep apnea-snoring-is stopped, it is important to have a sleep study before having this surgery.

Tracheostomy is a surgery used in severe sleep apnea. A small hole is made in the windpipe and a tube is inserted. Air will flow through the tube and into the lungs. This surgery is very successful but is needed only in patients not responding to all other possible treatments.

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Dr. Song remembers quite clearly the day he decided to become an ophthalmologist. He was a medical student at the New York University School of Medicine, completing his ophthalmology rotation, when he witnessed the life-changing impact that a corneal transplant had for a patient with severe keratoconus.

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